Conditional cash transfers and women's reproductive choices.

We study potential non-targeted effects of a large-scale national conditional cash transfer program-Peru's Juntos-on the fertility and reproductive decisions of adult beneficiaries. We use an event study design, exploiting time and geographic variation in the rollout of the program, to identify the causal effects of the program. We find that Juntos decreases the number of children that adult beneficiaries have and that these effects persist over time. We explore various mechanisms and find that Juntos does not affect fertility preferences but rather empowers women to avoid unwanted births. We provide evidence that this decrease is most likely due to better access to and more extensive use of modern birth control methods.

Validation and measurement properties of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) in Iranian couples.

BACKGROUND: One of the most important population challenges during the last three decades has been the significant decrease in the fertility rate worldwide. Since the validity and reliability of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) have not been determined in Iran, we conducted this study to assess psychometric characteristics of the MFKI and FFKI in couples in Tabriz and Urmia, Iran. METHODS: This was a cross-sectional study, as the first part (quantitative phase) of a sequential explanatory mixed-method study. The current study was done on 1200 participants (600 women with their husbands) living in the northwestern region of Iran, between January 2023 and September 2023. The psychometric properties of the Persian version of the tool (MFKI and FFKI) were performed in 5 stages, including translation process, content validity, face validity, construct validity and reliability assesment. RESULTS: In this study, the CVI, CVR, and impact scores of the MFKI tool were equal to 0.90, 0.88, 3.26 and CVI, CVR, and Impact scores of the FFKI tool were respectively equal to 0.95, 0.91 and 3.59, that it indicated a satisfactory level of content and face validity. Then, to check the construct validity, the results of the exploratory factor analysis of the MFKI tool on 13 items led to the identification of 3 factors, including Environment and reproductive health (ERH), Lifestyle factors (LSF) and Sperm quality (SQ), which explained 66% of the cumulative variance. The results of the exploratory factor analysis of the FFKI tool on 15 items led to the identification of 4 factors, including Reproductive health (RH), Lifestyle factors (LSF), Chance of conception (CHC) and Ovarian reserve and preservation (ORP), which explained 68% of the cumulative variance. CONCLUSIONS: The findings of this study indicated that the Persian version of MFKI and FFKI has acceptable psychometric properties to measure the awareness of Iranian couples regarding fertility, which can be used as a screening tool for fertility knowledge by health care professionals and also as a reliable tool in research.

The right to sexual and reproductive health (SRH) is considered one of the basic rights of couples all over the world. Increasing childbearing age is a global social issue. In spite of the policies of having children in the previous decade, fertility reduction and involuntary childlessness are still the foremost global health problems. The fertility rate in Iran has reduced significantly in the last thirty years. This reduction can be attributed not only to economic difficulties but also to the postponement of marriage and having children, as well as infertility issues, which, by increasing the awareness of couples about fertility, seems to be able to overcome this problem to some extent. Consequently, we decided to conduct this study with the aim of determining the psychometric properties of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) in Iranian couples. The results of the current study revealed that this questionnaire, having acceptable psychometric properties to evaluate the state of awareness of Iranian couples regarding fertility, can be used as a valid and reliable tool in Iranian couples. It appears that it is essential for health care providers to play an active role in advising couples about the appropriate age of fertility, the problems of delay in having children, overcoming the value of having few children in society. Accordingly, health policymakers should recommend the use of valid screening tools to identify the knowledge of women and men about fertility in health centers.

Cameroon's slow fertility transition: A gender perspective.

We interrogate the proposition that men's attitudes have constrained the fertility transition in Cameroon, where fertility remains high and contraceptive use low despite much socio-economic progress. We use five Demographic and Health Surveys to compare trends in desired family size among young women and men and analyse matched monogamous couple data from the two most recent surveys to examine wives' and husbands' desires to stop childbearing and their relative influence on current contraceptive use. In 2018, average desired family size was 5.6 and 5.1, for young men and women respectively, and this difference (half a child) has not changed since 1998. Among matched couples, the proportions wanting to stop childbearing were similar in wives and their husbands, but wives perceived husbands to be much more pronatalist than themselves. Surprisingly, men's own reported preferences were more closely associated with contraceptive use than wives' perceptions of husbands' preferences. We discerned little evidence that men's attitudes have impeded reproductive change.

Is the mortality-fertility nexus gendered? A research note on sex differences in the impact of sibling mortality on fertility preferences.

Research guided by demographic transition theory has shown that exposure to mortality influences women's fertility preferences and behaviours. Despite the myriad contexts, methodological approaches, and linkages featured in past studies, they have shared a focus on women, leaving questions on the gendered salience of mortality exposures for adults' fertility-related outcomes unanswered. In this research note, we analyse data from three African countries with distinct fertility profiles (Nigeria, Zambia, and Zimbabwe) to examine associations between sibling mortality exposure and ideal family size among women, men, and couples. We also investigate the stability of these associations over time. The associations between adults' sibling mortality exposure and their own and their spouses' ideal family sizes vary across countries. However, the gendered nature of the results in every country and evidence of cross-spousal effects uniformly demonstrate the need to incorporate sex differences into the study of the mortality-fertility link.

Fertility patterns and sex composition preferences in immigrant-native unions in Sweden.

Intermarriage between immigrants and native individuals highlights the need to study childbearing as a joint decision of couples, because fertility preferences are likely to differ for the two partners involved. This study focuses on Sweden, where the majority population holds a relative preference for daughters but many immigrants come from countries with son preferences. Using longitudinal registers for the period 1990-2009, I analyse third-birth risks according to the sex composition of previous children and type of union. Doing so allows the study of preferences from behavioural data: couples with a daughter preference, for example, are more likely to have another child if their two previous children were boys. Results show that third-birth risks tend to be higher in unions between Swedish women and immigrant men, whereas unions between Swedish men and immigrant women tend to exhibit lower third-birth risks. Son preferences are rarely realized in intermarriages.

How genuine are sub-replacement ideal family sizes in urban China?

Ideal family sizes remain at or above two in most low-fertility settings, but sub-replacement fertility ideals have been reported for urban China. The presence of restrictive family planning policies has led to a debate as to whether such ideals are genuine. This study exploits the ending of the one-child policy and the beginning of a universal two-child policy in October 2015 to investigate whether relaxing the restrictions led to an increase in ideal family size. We apply difference-in-differences and individual-level fixed-effect models to longitudinal data from a near-nationwide survey. For married individuals aged 20-39, relaxing the restrictions from one to two children increased the mean ideal family size by around 0.2 and the proportion who desired two or more children by around 19 percentage points. Findings suggest that although reported ideal family sizes have been reduced by policy restrictions, sub-replacement ideal family sizes in urban China appear to be genuine.

Exploring fertility preferences among women aged 15-24 in the Democratic Republic of Congo.

The DRC has one of the highest fertility rates globally, yet research on fertility preferences in the country remains limited. This study aims to identify the factors contributing to the persistence of high fertility preferences among young and adolescent women (15-24) in the DRC. Using data from the 2013-2014 DHS, the study examines fertility preferences by transition stage. Multinomial logistic regression analysis is used to identify the characteristics associated with mid- (4-5 children) and pre-transitional (6+ children) as opposed to post-transitional (0-3 children) preferences. Results reveal that 43% of the women prefer 6+ children. The relative risk of fertility preference varies significantly based on characteristics such as age, literacy, place and province of residence, religion, employment status, wealth, acceptance of domestic violence, and knowledge of modern family planning methods. The findings provide evidence for both the diffusion and socio-economic theory of fertility decline.

Perceptions of Partners' Fertility Preferences and Women's Covert Contraceptive Use in Eight Sub-Saharan African Countries.

Covert use of contraception is a common but underreported and understudied phenomenon where one partner uses contraception without the other's knowledge. We used Demographic and Health Survey couple data to examine the relationship between wives' perceptions of husbands' fertility preferences and type of contraceptive use (overt vs. covert) in Benin, Ethiopia, Kenya, Mali, Nigeria, Sierra Leone, Uganda, and Zambia using logistic regression. Wives who perceived that their husbands wanted more children than them had increased odds of using covertly, compared to those who perceived that husbands wanted the same number of children in all countries except Benin, and the strength of the relationships ranged from adjusted odds ratio (aOR) 2.89 (95 percent confidence interval (CI) 1.75-4.76) in Zambia to aOR 4.01 (95 percent CI 1.68-9.58) in Mali. Wives who reported not knowing their husbands' fertility preferences had increased odds of using covertly compared to wives who perceived that their husbands wanted the same number of children in all countries except Zambia, ranging from aOR 2.02 (95 percent CI 1.11-3.69) in Ethiopia to aOR 3.82 (95 percent CI 2.29-6.37) in Kenya. Our findings indicate that efforts to increase partner engagement to align couple's fertility preferences may encourage overt use.

Multiple Perspectives on Recent Trends in Unwanted Fertility in Low- and Middle-Income Countries.

The last four decades have witnessed large declines in fertility globally. This study uses data from 78 low- and middle-income countries to examine concurrent trends in unwanted fertility. Three measures of unwanted fertility are contrasted: the conventional unwanted total fertility rate, a proposed conditional unwanted fertility rate, and the percentage of births unwanted. Incidence of unwanted births and prevalence of exposure to unwanted births are both derived from answers to questions on prospective fertility preference, recognized as the most valid and reliable survey measure of preferences. Country-level trends are modeled both historically and with the decline in total fertility, with a focus on regional differentials. Results show that unwanted fertility rates-especially the conditional unwanted fertility rate-have declined substantially in recent decades. By contrast, the percentage of births unwanted has declined less, remaining stable or even increasing: from a birth cohort perspective, declines in unwanted fertility have been far more modest than the increased parental success in avoiding unwanted births. The regional patterns suggest that sub-Saharan Africa has several similarities with other major regions but also some peculiar features, including a recent stall in the decline of unwanted fertility that persists after controlling for the stage of fertility transition.

The illusion of stable fertility preferences.

Fertility preferences have long played a key role in models of fertility differentials and change. We examine the stability of preferences over time using rich panel data on Kenyan women's fertility desires, expectations, actual fertility, and recall of desires in three waves over a nine-year period, when respondents were in their 20s. We find that although desired fertility is quite unstable, most women perceive their desires to be stable. Under hypothetical future scenarios, few expect their desired fertility to increase over time but, in fact, such increases in fertility desires are common. Moreover, when asked to recall past desires, most respondents report previously wanting exactly as many children as they desire today. These patterns of bias are consistent with the emerging view that fertility desires are contextual, emotionally laden, and structured by identity.

Nigerian international migrants: A qualitative discourse on fertility preferences and outcomes.

The movement of people across international boundaries have been recognized as having serious implication for life-style that migrants experience and manifest after returning from sojourning. This was a qualitative survey of female Nigerian international migrants and their fertility preferences and outcomes. The study explored how the role of length of stay abroad affected their fertility preferences, age at migration and fertility preferences and outcomes and the effect of culture on fertility preferences and outcomes. Results indicated that the length of stay created a change in the migrant's fertility preferences adopting the fertility regime of the country they migrated to. Age at migration was also recognized as playing a significant role in changing the fertility preferences and outcomes of migrants. It is therefore pertinent to note that migration plays a dominant role in changing the fertility preferences of migrants.

A Panel Study of Fertility Preferences and Contraceptive Dynamics in the Presence of Competing Pregnancy Risks in Uganda.

Although many studies have examined the influence of women's fertility preferences on subsequent fertility behavior and the role of contraceptive use intentions on unmet need, very few have explored their concurrent effects on contraceptive use dynamics. This study examines the independent concurrent effects of women's fertility preferences and contraceptive intentions on subsequent adoption and discontinuation, treating pregnancy as a competing risk factor that may alter contraceptive need. The data are derived from a 2018 follow-up survey of a 2014 national sample of 3,800 Ugandan female respondents of childbearing age. The survey included a contraceptive calendar that recorded pregnancy, birth, and contraceptive event episodes, including reasons for discontinuation. We use competing risk regression to estimate the effect of fertility preferences and contraceptive intentions on the cumulative incidence function of contraceptive behaviors, accounting for intervening pregnancy, female background covariates, loss to follow-up, and complex survey design. We find that women's contraceptive intentions significantly increase the rate of contraceptive adoption. After having adopted, women's contraceptive intentions have been realized and do not prolong use. The risk of discontinuation among women who adopted after baseline was significantly higher than for those using at baseline, irrespective of their initial intentions. The effectiveness of the type of contraceptive method chosen significantly lowered discontinuation risk. Fertility preferences were not significantly associated with either time to adoption or discontinuation. The pace of the fertility transition in this sub-Saharan African setting is likely being shaped by reproductive regulation through the intentional use of contraception that enables spacing births.

Investigating the Relationship between Food Insecurity and Fertility Preferences in Tanzania.

OBJECTIVE: We analyze fertility preferences among women at risk of pregnancy with children ages five or younger as a function of two food security metrics: perceptions of household hunger and child stunting (height for age z scores ≤ -2.0) in order to convey a robust picture of food insecurity. METHODS: We use data from the 2016 Tanzania Demographic and Health Surveys to analyze this research question. Multinomial generalized logit models with cluster-adjusted standard errors are used to determine the association between different dimensions of food insecurity and individual-level fertility preferences. RESULTS: On average, women who experience household hunger are 19% less likely to want more children compared to women who do not experience household hunger (AOR: 0.81, p = 0.02) when controlling for education, residence, maternal age, number of living children, and survey month. Adjusting for the same covariates, having at least one child ≤ 5 years old who is stunted is associated with 13% reduced odds of wanting more children compared to having no children stunted (AOR: 0.87, p = 0.06). CONCLUSIONS FOR PRACTICE: In the context of a divided literature base, this research aligns with the previous work identifying a preference among women to delay or avoid pregnancy during times of food insecurity. The similarity in magnitude and direction of the association between food insecurity and fertility preferences across the two measures of food insecurity suggest a potential association between lived or perceived resource insecurity and fertility aspirations. Further research is needed in order to establish a mechanism through which food insecurity affects fertility preferences. SIGNIFICANCE STATEMENT: Individual fertility preferences are sensitive to dynamic multi-level factors in a woman's life. While qualitative research has explored the effect that food insecurity and associated resource constraints have on fertility preferences, results are conflicting. Here, we quantitatively examine how individual woman's fertility preferences associate with two measures of food insecurity and qualitatively compare the associations across food insecurity measures. We establish that two food insecurity measures- household hunger and child stunting- capture similar populations and have similar associations with fertility preferences. This is a critical step forward in understanding the dynamic relationship between resource availability, child well-being, and fertility preferences.

Unmet Need for Family Planning after Internal Migration: Analysis of Ethiopia 2017-2018 PMA Survey Data.

Internal migration's effect on family planning behavior depends upon migration circumstances. While many studies describe instability and displacement's effect on family planning access, fewer studies consider the positive association between internal migration and family planning behavior. Using Performance Monitoring for Action (PMA) survey data, we examine the relationship between internal migration and unmet need for family planning in Ethiopia from 2017-2018. We describe determinants of family planning behavior by migrant status and model migration's effect on unmet need for family planning using multilevel logistic regression. Internal migrants studied tend to be more educated and wealthier and have less unmet need than non-migrants, likely due to different fertility preferences and human capital. This contributes to existing research by illustrating how rural-urban migration in Ethiopia relates to family planning behaviour. Findings will be of interest to social scientists and policymakers evaluating family planning resource allocation to reduce unmet need in African contexts.

Sibling loss and fertility desires in the high-mortality context of Peru.

Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.

Fertility preferences and subsequent childbearing in Africa and Asia: A synthesis of evidence from longitudinal studies in 28 populations.

Survey data on fertility preferences have played a central but controversial role in fertility research and advocacy for family planning. We summarize evidence from longitudinal studies in 28 Asian and African populations on the relationship between preferences and subsequent childbearing. While we found no consistent association between women's desire to delay childbearing and subsequent fertility, the baseline desire of women to stop childbearing was a powerful predictor of subsequent fertility in all populations and increased in strength as overall contraceptive use in the study populations rose. Partners' desire also exercised some influence but was of modest importance in most populations. However, the correspondence between desire to stop and behaviour was found to be far from perfect. Weak implementation of preferences by contraception is likely to be the major cause of this preference-behaviour discrepancy. Uncertainty and instability in preferences may also contribute to the discrepancy, particularly in sub-Saharan Africa.

Childbearing desires and behaviour: a prospective assessment in Nairobi slums.

BACKGROUND: Advancing an understanding of childbearing desires is an important precursor to achievement of the policy goal of reducing unintended pregnancies. It has been long debated that concepts of fertility desires and planning may be particularly problematic in sub-Saharan Africa. However, examination of the utility of fertility preference measures and their link to reproductive behaviour is still rare in the region. The aim of this study is to assess the predictive validity of future childbearing desires on subsequent reproduction among women living in the highly unpredictable circumstances of Nairobi slums. METHODS: We used data from a longitudinal study (2007-2010) nested in the Nairobi Urban Health Demographic Surveillance System that is located in two slums in Nairobi, Kenya. We analysed baseline fertility desires among 4577 postpartum women. Cox proportional hazard model was employed to examine the effect of fertility desires on subsequent reproduction. RESULTS: One-third of the women wanted no more children and 37% wanted to wait for at least five years at baseline. While two-thirds of the women who wanted to have a child soon became pregnant within three years, less than one-third of those wanting no more children became pregnant. The multivariable analysis shows that the probability of becoming pregnant among women who expressed desires to stop or delay childbearing at least for five years was 50% less than among women who wanted to have a child in two to four years. In addition to prospective fertility desires, level of woman's education, residence and ethnicity exerted important influences on implementation of baseline preferences. CONCLUSIONS: Our study finds a strong link between baseline fertility desires and subsequent reproduction. A large difference in pregnancy risk was observed between those who wanted no more children and those who wanted another child. The link between a woman's stated desire to stop childbearing and subsequent childbearing is just as strong in the Nairobi slums as elsewhere. In addition, the findings revealed a pronounced gradient in pregnancy risk according to preferred spacing length, which support other evidence on the important contribution of long-term spacing or postponement to fertility decline in sub-Saharan Africa.

Women's empowerment and fertility preferences in high fertility countries in Sub-Saharan Africa.

BACKGROUND: Nearly all countries with fertility levels of more than five children per woman are in Sub-Saharan Africa. Prestige, insurance in old age, and replacement in case of child deaths are related to preferences for large families. In this paper, we examine the association between women's empowerment and fertility preferences of married women aged 35 years and above in four high fertility Francophone Sub-Saharan Africa (FSSA) countries, namely Burkina Faso, Mali, Niger and Chad. METHOD: The ideal number of children among married women and their ability to have the desired number of children are used to measure fertility preferences. We used principal component analysis to construct a multidimensional empowerment index. We then estimated negative binomial and logistic regression models to examine the association between women's empowerment and fertility preferences. Data are from the most recent Demographic and Health Surveys (DHS) conducted in the countries included in the analysis. RESULTS: Regardless of the country, more empowered women desire significantly fewer children compared with their less empowered counterparts. The first step to having fewer children is formulating programs to improve economic empowerment of women. The specific elements of women's empowerment that were important for fertility preferences included education, skills development, decision-making power, and control over household resources. In addition, familial empowerment matters more than other dimensions of empowerment in influencing women's ability to achieve the desired number of children in the FSSA countries included in the study. CONCLUSION: Paid employment and access to and control over resources are factors which, if improved upon, could significantly reduce the ideal number of children. By taking necessary steps, mass media can be used much more adequately to reduce ideal number of children in FSSA countries. In addition, the desire for many children could also be due to their participation in income-generating activities to improve the household's socio-economic status. The findings suggests that improvement of women's ability to have the desired number of children is a big challenge to which policy makers must pay careful attention.

Exploring Multiple Dimensions of Young Women's Fertility Preferences in Malawi.

INTRODUCTION: Standard survey measures of fertility preferences, such as the desire for and preferred timing of future births, do not capture the complexity of individuals' preferences. New research focuses on additional dimensions of emotions and expectations surrounding childbearing. Few quantitative studies, however, consider the influence of all three dimensions of fertility preferences concurrently. METHODS: Using longitudinal survey data from the Tsogolo la Thanzi project (2009-2012) in Malawi, this study employed logistic regression analysis to investigate the influence of young women's emotions, expectations, and a standard measure of fertility preferences on pregnancy and modern contraceptive use. RESULTS: Young women experienced high unmet need; across survey waves, over three-quarters of women who desired a child in more than 2 years were not currently using modern contraceptives and over three-quarters of women who thought a pregnancy in the next month would be bad news (garnered from a measure of emotions surrounding pregnancy) were not currently using modern contraceptives. In regression models including all three measures of fertility preferences, each was significantly associated with the likelihood of a future pregnancy. The standard measure and emotions measure were significantly associated with modern contraceptive use. DISCUSSION: Emotions and expectations surrounding pregnancy and childbirth appear to be distinct and salient aspects of fertility preferences in addition to the standard measure. A better understanding of the multidimensional nature of fertility preferences will help individuals define and achieve their reproductive goals and obtain appropriate services. Furthermore, future research should incorporate new measures of fertility preferences into surveys internationally.

Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study.

BACKGROUND: Persistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting. METHODS: Using data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men's and women's reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women's empowerment (household and fertility decision-making, women's education, and women's knowledge of contraception). RESULTS: When individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women's empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband's education, husband's familiarity with contraception, and number of children. CONCLUSIONS: Overall there were clear patterns to differential reporting. Associations with women's empowerment and contraceptive communication and use suggest a strategy of women's empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences. TRIAL REGISTRATION: Clinical Trials Number: NCT01593943 , registered May 4, 2012 at clinicaltrials.gov.